TPOAb阳性孕妇分娩时点母血与脐带血TPOAb IgG各亚类及Th1，Th17相关因子的相关性研究

发布时间：2018-05-20 17:28

  本文选题：甲状腺过氧化物酶抗体 + 妊娠　； 参考：《青岛大学》2017年硕士论文

【摘要】：目的:本研究通过分析母血及脐带血TPOAb水平、TPOAb IgG各亚类胎盘通过能力及TPOAb与Th1,Th17细胞亚群相关因子TNF-α、IFN-γ、IL-17、IL-22的关系,探讨TPOAb可能的作用机制,为今后更进一步了解TPOAb的生物学行为提供基础依据。方法:随机选取2015.8-2016.3期间在我院产科进行常规产前检查和分娩的12例TPOAb阳性(观察组)及22例TPOAb阴性且无甲状腺疾病病史(对照组)妊娠妇女作为研究对象。测定观察组及对照组妊娠妇女分娩前静脉血(母血)及分娩后新生儿脐带静脉血(脐带血)的TPOAb、TSH、FT4、FT3水平、TPOAb IgG各亚类及TNF-α、IFN-γ、IL-17、IL-22水平。(1)分别比较观察组与对照组中母血及脐带血中TPOAb、TSH、FT4、FT3水平、TPOAb IgG各亚类及TNF-α、IFN-γ、IL-17、IL-22水平的差异性;(2)比较观察组中母血与脐带血TPOAb、TSH、FT4、FT3水平及TNF-α、IFN-γ、IL-17、IL-22的差异性,计算TPOAb IgG各亚类胎盘通过率;(3)进一步分析观察组母血及脐带血中TPOAb水平与TNF-α、IFN-γ、IL-17、IL-22的相关性。结果:(1)与对照组母血间比较:(1)观察组母血TPOAb水平明显升高(P=0.000),(2)观察组母血TPOAb IgG总、IgG1均升高(分别P为0.012、0.016),(3)观察组母血TNF-α、IFN-γ、IL-17、IL-22水平均明显升高(分别P为0.039、0.031、0.010、0.000),(4)两组间其余各指标比较,均无显著性差异(均P0.05);(2)与对照组脐带血比较:(1)观察组脐带血TSH、TPOAb水平升高(分别P为0.044、0.000),FT3水平降低(P=0.033),(2)观察组脐带血TPOAb IgG总、IgG1均明显升高(分别P为0.002、0.025),(3)观察组脐带血TNF-α、IFN-γ、IL-17、IL-22水平也均显著升高(分别P为0.008、0.024、0.027、0.016),(4)两组间其余各指标比较,均无显著性差异(均P0.05);(3)观察组脐血与母血间比较:(1)脐带血TSH、FT4水平高于母血中水平(分别P为0.006、0.000),(2)脐带血FT3水平低于母血中水平(P=0.000),(3)脐带血与母血间TPOAb水平无显著差异(P0.05),(4)观察组IgG各亚类胎盘通过状态呈IgG1=IgG3IgG2=IgG4,即IgG1胎盘通过率高于IgG2及IgG4(分别P为0.004、0.028),IgG3胎盘通过率高于IgG2及IgG4(分别P为0.003、0.019);(4)对照组脐血与母血间比较:(1)脐带血TSH、FT4水平高于母血中水平(分别P为0.000、0.000),(2)脐带血FT3、TPOAb水平低于母血中水平(分别P为0.000、0.000),(3)对照组IgG各亚类胎盘通过状态为IgG1=IgG4IgG2=IgG3,即IgG1胎盘通过率高于IgG2及IgG3(P值分别为0.000、0.000),IgG4胎盘通过率高于IgG2及IgG3(P值分别为0.027、0.006);(5)观察组各指标间相关性分析:(1)母血TPOAb与脐带血TPOAb水平呈正相关(r=0.636,P=0.000),母血中TPOAb水平与母血中TNF-α、IFN-γ、IL-17、IL-22均成正相关(分别r为0.686、0.689、0.661、0.591;分别P为0.014、0.013、0.019、0.043);(2)脐带血TPOAb水平与脐带血TSH水平成正相关(r=0.930,P=0.000),脐带血TPOAb水平与脐带血TNF-α、IFN-γ、IL-17、IL-22均不相关(均P0.05);(3)母血与脐带血中TNF-α、IFN-γ、IL-17、IL-22水平均不相关(均P0.05)。结论:1.母体TPOAb阳性可能会对新生儿甲状腺功能产生影响;2.母体TPOAb阳性分娩前母血及脐带血以TPOAb IgG1亚类升高为主;3.母体TPOAb阳性妊娠末期以TPOAb IgG1、IgG3亚类胎盘通过率最高;4.母体TPOAb阳性可能通过Th1,Th17细胞亚群相关因子TNF-α、IFN-γ、IL-17、IL-22等介导母儿免疫损伤。
[Abstract]:Objective: by analyzing the TPOAb level of maternal blood and umbilical cord blood, the passing ability of TPOAb IgG subclass placenta and the relationship between TPOAb and Th1, Th17 cell subgroup related factors TNF- a, IFN- gamma, IL-17 and IL-22, the mechanism of TPOAb possible action is explored to provide the basis for further understanding of the biological behavior of TPOAb. Method: 2015.8 During the period of -2016.3, 12 cases of TPOAb positive (observation group) and 22 cases of TPOAb negative and no history of thyroid disease (control group) were used in the obstetrics and Gynecology of our hospital as the study subjects. The TPOAb of the observation group and the control group of pregnant women before delivery (mother blood) and the umbilical cord blood (cord blood) of the newborn infants after delivery TSH, FT4, FT3 levels, TPOAb IgG subclasses and TNF- alpha, IFN- gamma, IL-17, IL-22 levels. (1) the differences in the level of TPOAb, TSH, FT4, and umbilical blood in the maternal and umbilical cord blood of the observation group and the control group were compared respectively; (2) the level of maternal blood and umbilical cord blood in the observation group was compared. The difference between IL-17 and IL-22 was used to calculate the placental passing rate of each subclass of TPOAb IgG; (3) the correlation between the level of TPOAb in the maternal and umbilical cord blood of the observation group was further analyzed with TNF- alpha, IFN- gamma, IL-17 and IL-22. (1) (1) the level of mother blood TPOAb increased significantly (P=0.000) in the observation group (2) the mother blood of the observation group increased (1). P was 0.012,0.016), and (3) the level of TNF- a, IFN- gamma, IL-17 and IL-22 in the mother blood of the observation group increased significantly (P 0.039,0.031,0.010,0.000 respectively), and (4) the remaining indexes of the two groups were not significantly different (all P0.05); (2) the umbilical cord blood of the control group was compared with that of the control group: (1) the umbilical cord blood TSH, TPOAb level increased (respectively). Low (P=0.033), (2) the total TPOAb IgG of umbilical cord blood in the observation group increased significantly (P 0.002,0.025), and (3) the level of umbilical cord blood TNF- a, IFN- gamma, IL-17 and IL-22 increased significantly (P 0.008,0.024,0.027,0.016), and (4) there was no significant difference between the two groups, and (3) the comparison between the umbilical cord blood and the mother blood in the observation group: (3): (3) the comparison between the umbilical cord blood and the mother blood in the observation group: (1) the level of TSH and FT4 in umbilical cord blood was higher than that in the mother blood (P 0.006,0.000 respectively), and (2) the level of FT3 in umbilical cord blood was lower than that of the mother blood (P=0.000). (3) there was no significant difference in the TPOAb level between the umbilical cord blood and the mother blood (P0.05), (4) the passing state of the placenta in the IgG subgroups of the observation group was IgG1=IgG3IgG2=IgG4, that is, the rate of IgG1 placenta was higher than that of IgG2 and 0.004. (0.004 0.028), the passing rate of IgG3 placenta was higher than that of IgG2 and IgG4 (P 0.003,0.019 respectively), and (4) comparison between the umbilical cord blood and the mother blood in the control group: (1) the umbilical cord blood was TSH, the level of FT4 was higher than the level of the mother blood (P is 0.000,0.000), (2) the umbilical cord blood FT3, TPOAb level was lower than that of the mother blood (respectively), and (3) the placenta passing state of the control group was (3) The passing rate of G4IgG2=IgG3, IgG1 placenta was higher than that of IgG2 and IgG3 (P value was 0.000,0.000), and the passing rate of IgG4 placenta was higher than IgG2 and IgG3 (P value was 0.027,0.006). (5) correlation analysis between the indexes of the observation group: (1) there was a positive correlation between the maternal blood TPOAb and the level of umbilical cord blood. IL-22 was positively correlated (r was 0.686,0.689,0.661,0.591, P was 0.014,0.013,0.019,0.043 respectively); (2) the level of umbilical cord blood TPOAb was positively correlated with the level of umbilical cord blood TSH (r=0.930, P=0.000). The level of TPOAb in umbilical cord blood was not related to TNF- alpha, IFN- gamma, and umbilical cord blood. Mean unrelated (mean P0.05). Conclusion: 1. maternal TPOAb positive may affect the thyroid function of newborns; 2. maternal TPOAb positive maternal and umbilical cord blood before delivery of TPOAb IgG1 subclass; 3. maternal TPOAb positive pregnancy at the end of TPOAb IgG1, the IgG3 subclass placental pass rate is the highest; 4. mother TPOAb positive may pass Th1, Th17 thin Cell subgroup related factors TNF- alpha, IFN- gamma, IL-17 and IL-22 mediate maternal and fetal immune injury.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256

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